STATE OF FLORIDA an 1 03 DIVISION OF ADMINISTRATIVE HEARINGS NAVARRO DISCOUNT PHARMACIES ; NO. 2, INC. D/B/A NAVARRO DISCOUNT ; co PHARMACY #2, Petitioner, vs. CASE NO. 01-1971 ‘oes Beardvhon No AHGAOS Os STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. / FINAL ORDER THE PARTIES resolved all disputed issues and executed a Settlement Agreement, which is incorporated by reference. The parties are directed to comply with the terms of the attached settlement agreement. Based on the foregoing, this file is CLOSED. DONE and ORDERED on this the _/!_ day of Qype _, 2003, in Tallahassee, Florida. A PARTY WHO IS ADVERSELY AFFECTED BY THIS FINAL ORDER IS ENTITLED TO A JUDICIAL REVIEW WHICH SHALL BE INSTITUTED BY FILING ONE COPY OF A NOTICE OF APPEAL WITH THE AGENCY CLERK OF AHCA, AND A SECOND COPY ALONG WITH FILING FEE AS PRESCRIBED BY LAW, WITH THE DISTRICT COURT OF APPEAL IN THE APPELLATE DISTRICT WHERE THE AGENCY MAINTAINS ITS HEADQUARTERS OR WHERE A PARTY RESIDES. REVIEW PROCEEDINGS SHALL BE CONDUCTED _ IN ACCORDANCE WITH THE FLORIDA APPELLATE RULES. THE NOTICE OF APPEAL MUST BE FILED WITHIN 30 DAYS OF RENDITION OF THE ORDER TO BE REVIEWED. Copies furnished to: L. William Porter II, Esquire Agency for Health Care Administration (Interoffice Mail) Lester J. Perling, Esquire Broad and Cassel 100 N. Tampa Street, Suite 3500 Tampa, Florida 33602 (U.S. Mail) Michael M. Parrish Administrative Law Judge Division of Administrative Hearings The DeSoto Building 1230 Apalachee Parkway Tallahassee, Florida 32399-3060 Tim Byrnes, Chief, Medicaid Program Integrity Kelly Rubin, Medicaid Program Integrity John Hoover, Finance and Accounting CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true and correct copy of the foregoing has been furnished to the above named addressees by U.S. Mail on this the WZeaay oLlt Gus We, 2003. ; | Chase Uleuison Lealand McCharen, Esquir Agency Clerk State of Florida Agency for Health Care Administration 2727 Mahan Drive, Building #3 Tallahassee, Florida 32308-5403 (850) 922-5873 STATE OF FLORIDA DIVISION OF ADMINISTRATIVE HEARINGS NAVARRO DISCOUNT PHARMACIES NO. 2, INC. D/B/A NAVARRO DISCOUNT PHARMACY NO. 2, Petitioner, vs. CASE NO. 01-1971 STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION, Respondent. : / SETTLEMENT AGREEMENT STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION (“AHCA” or “the Agency”), and Navarro Discount Pharmacies No. 2, Inc. d/b/a Discount Pharmacy #2 (“PROVIDER”), its parent, successors in interest and assigns, affiliates, subsidiaries, related entities and their officers, agents, representatives, attorneys, fiduciaries, administrators, directors, stockholders, employees or former employees by and through the undersigned, hereby stipulate and agree as follows: 1. Tais Agreement is entered into between the parties for the purpese of resolving, the disputes between them and avoiding the costs and burdens of further litigation. Neither party concedes the other’s position. 2. PROVIDER is a Medicaid provider in the State of Florida, provider number 104759100 and was a provider during the audit period. 3. In its final agency audit report (final agency action) dated April 6, 2001, AHCA notified PROVIDER that review of Medicaid claims performed by Medicaid Program Integrity Navarro Discount Pharmacy No. 2 Settlement Agreenent (MPI), Office of the Inspector General, indicated that certain claims, in whole oz in part, were not covered by Medicaid. The Agency sought recoupment of this overpayment, in the amount of $15,487.51. In response to the audit letter dated April 6, 2001, PROVIDER filed a petition for a formal administrative hearing, which was assigned DOAH Case No. 01-1971. 4. Subsequent to the original audit that took place in this matter and in preparation for trial, AHCA re-reviewed the PROVIDER’s claims and evaluated additional documentation submitted by the PROVIDER. As a result, AHCA determined that the overpayment was adjusted to $8,753.20. Further claims review resulted in a subsequent adjustment to the demand to the final demand amount of $5,987.92. 5. In order to resolve this matter without further administrative proceedings, PROVIDER and the AHCA expressly agree as follows: (1) AHCA agrees to accept the payment set forth herein in settlement of the overpayment issues arising from the MPI review. Q) Within thirty days of receipt of the final order, PROVIDER agrees to make a lump sum payment of five thousand nine hundred eighty seven dollars and ninety-two cents ($5,987.92) in full and complete settlement of all claims in the proceedings before the Division of Administrative Hearings (DOAH Case No. 01-1971). AHCA retains the right to perform a 6-month follow-up review. @) PROVIDER and AHCA agree that full payment as set orth above will resolve and settle this case completely and release both parties from all liabilities arising from the findings in the audit referenced as C.I. 01-0305- 000-3. Navarro Discount Pharmacy No. 2 Settlement Agreement (4) PROVIDER agrees that it will not rebill the Medicaid Program in any manner for claims that were not covered by Medicaid, which are the subject of the audit in this case. 6. Payment shall be made to: AGENCY FOR HEALTHCARE ADMINIST RATION Medicaid Accounts Receivable Post Office Box 13749 Tallahassee, Florida 32317-3749 7. PROVIDER agrees that failure to pay any monies due and owing under the terms of this Agreement shall constitute PROVIDER’S authorization for the Agency, without further notice, to withhold the total remaining amount due under the terms of this agreement from any monies due and owing to PROVIDER for any Medicaid claims. 8. AHCA reserves the right to enforce this Agreement under the laws of the State of Florida, the Rules of the Medicaid Program, and all other applicable rules and regulations. 9. Tais settlement does not constitute an admission of wrongdoing, violation of any order, law, statute, duty, or contract, or error by either party with respect to this case or any other matter. Compliance with this Agreement shall not be construed as an admission by PROVIDER of any monetary liability. 10. Each party shall bear its own attorneys’ fees and costs, if any. 11. The signatories to this Agreement, acting in a representative capacity, represent that they are duly authorized to enter into this Agreement on behalf of the respective parties. 12. This Agreement shall be construed in accordance with the provisions of the laws of Florida. Venue for any action arising from this Agreement shall be in Leon County, Florida. 13. This Agreement constitutes the entire agreement between PROVIDER and the AHCA, including anyone acting for, associated with or employed by them, concerning all Navarro Discount Pharmacy No. 2 Settlement Agreement matters and supersedes any prior discussions, agreements or understandings; there are no promises, representations or agreements between PROVIDER and the AHCA other than as set forth herein. No modification or waiver of any provision shall be valid unless a written amendment to the Agreement is completed and properly executed by the parties. 14. This is an Agreement of settlement and compromise, made in recognition that the parties may have different or incorrect understandings, information and contentions, as to facts and law, and with each party compromising and settling any potential correctness or incorrectness of its understandings, information and contentions as to facts and law, so that no misunderstanding or misinformation shall be a ground for rescission hereof. 15. PROVIDER expressly waives in this matter its right to any hearing pursuant to sections 120.569 or 120.57, Florida Statutes, the making of findings of fact and conclusions of law by the Agency, and all further and other proceedings to which it may be entitled by law or rules of the Agency regarding this proceeding and any and all issues raised herein. PROVIDER further agrees that it shall not challenge or contest any Final Order entered in this matter which is consistent with the terms of this settlement agreement in any forum now or in the future available to it, including the right to any administrative proceeding, circuit or federal court action or any appeal. 16. This Agreement is and shall be deemed jointly drafted and written by all parties to it and shall not be construed or interpreted against the party originating or preparing it. 17. To the extent that any provision of this Agreement is prohibitec. by law for any reason, such provision shall be effective to the extent not so prohibited, and such prohibition shall not affect any other provision of this Agreement. Navarro Discount Pharmacy No. 2 Settlement Agreement 18. This Agreement shall inure to the benefit of and be binding on each party’s successors, assigns, heirs, administrators, representatives and trustees. 19, All times stated herein are of the essence of this Agreement. 20. This Agreement shall be in full force and effect upon execution by the respective parties in counterpart. O DISCOUNT PHARMACIES NO. 2 d/b/a NAVARRO DISCOUNT PHARMACY Dated: 7 ! ¢ , 2003 AGENCY FOR HEALTH CARE ADMINISTRATION 27271 Mahan Drive, Mail Stop #3 Tallahassee, FL 32308-5403 —_—___ Dated: Deak || 2003 RufesNobte Judd tHe Ae “ Inspector General Lito MEE vated: Aputt SX _.2003 Valda Clark Christian General Counsel owe — pate: 24-227 2008 éWilliam Porter II Assistant General Counsel ¥ s » 24/18/2881 18:44 365-634-0851 NAVARRO DC STATE OF FLORIDA . : My, JEB BUSH, GOVERNOR ! | Cy 8A, yh April 6, 2002 _ en Nas Vi Provider No. _. License No. ~H0007783°~ Jose F. Navarro, President RE . aerate Discount, Pharmacies No. ‘s Inc. : d/b/a Navarro Discount Pharmacy #2 3949 8.W. 6 street : APR 350 2008 Miami, Florida 33134 - oe ; 1 . - * CERTIFIED MATL: — RETURN RECEIPT 7099 3400 0013 8445 ase MEDICAID PROGRAM RE: FINAL AGENCY AUDIT REPORT , _ INTEGRITY C.1. No. 01-0305-000-3/H/KDR : Dear Mr. Navarro: An, on-site audit of your pharmacy was initlated on October 16, 2000. The Florida Medicaid Program throug the Agency for Health Care Administration has détermined that you have been overpaid $15,487.51 in connection with claims submitted to Medicaid during the audit period(s) specified. This conclusion is supported by the audit results. oo, . This review and the determinations were made in accordance with the provisions of Chapter 409, Florida Statutes (F.S.), and. . Chapter 59G, Florida Administrative Code (F.A.C.}. Tn applying for Medicaid reimbursement, providers are required to follow the applicable statutes, rules, Medicaid provider handbooks, statements of Medicaid policy, and federal laws and regulations. Madicaid cannot properly pay for claims that do not meet Medicaid requirements. When a provider receives payment in .violation of these provisions, those funds must be repaid. REVIEW DETERMINATIONS The audit included an analysis of a randon sampling of claims submitted during the audit period. The audit period for this review was from January 1, 1999, through July 21, 2000. This review identified a non-extrapolated overpayment of $13.95. Retached is an itemized listing of discrepancies noted in the review of the random sample. oo ; The audit also included a comparison of your lawful documented product acquisitions with your paid Medicaid claims. The audit period for this review was from January 1. 1999, through July 21, 5000. The drug quantity billed to Medicald, in many instances, — Vistt ABCA Online at www. fake. srote Jius © 2727 Mahan Drive « Mall Grop #6 Tablahassco, FL 37308 ETv7EB'd auoud 2S:8A TAAZ—-RT—Nu . _ _ 94/18/2001 19:44 395-634-2251 NAVARRO De ‘PAGE 63 Jose F. Navarro, Prasident “°° ™ Navarro Discount Pharmacies No. 2, Inc. d/b/a Navarro Discount Pharmacy #2 page 2 . |: ee . exceeded the quantity available to dispense ‘to Medicaid recipients. This review identified an overpayment of $15,473.52. Attached are ~ the ovérpayment calcplations...-.- ---: see ee hos he We have combined the non-extrapolated overpayment findings with the acquisition shortage overpayment. Aeccrdingly, we have determined at this time that you have been overpaid by the Medicaid program in the amount of $15,487.81 20 00 If you accept or concur with these findings, please send your | check in the amount of $15,487.51, for the identified : ; ‘overpayment, made payable to the Florida Agency for Health Cara Administration, to: on wee eR DN, SOLIS SUSTAINS Se yer ee 6 . Agency for Health Care Administration Medicaid Accounts Receivable “*"°""’ Post Office Box 13749 ; Tallahassee, Florida 32317-3749 (Note: The check must be payable to the Florida Asency for » Health Care Administration, not to any employee of the . 0... agency.) To ensure proper credit, ba sure that your” provider number is shown on your check. Questions regarding payment should be directed to Ms. Willie Bivens at (850) 487-4298, ~ vos sem - You have the vignt to request a formal or informal hearing pursuant to section 120,569, F.S. If a petition for formal © hearing is made, the petition must be made in compliance with rule section 28-106.201, F.A.c. Please nete that rule section 28-106,201(2), F.A.C., specifies that the petition shal. contain a concise discussion of specific items in dispute ™ — Additionally, you are hereby informed that if a request for a hearing is made, the request or petition must be received within twenty-one (21) days of receipt of this letter. Failure ta .timely’ request a hearing shall be deemed 2 waiver of your right to a hearing. ; ; : a . ‘It is important that a request for an informal hearing or a ‘petition for a formal hearing be sent only to the following address: : : Mr. Charles G. Ginn, Chief R E C E] V E D Medicaid Program Integrity ~ : . Office of the Inspector General APR 30 200} Agency for Health Care Administration , Mahan Drive, Mail Stop # 6 Mi Tallahassee, Florida 32306-5403 en PROGRAM Do not send requests ox petitions to any other address. If a hearing request is not received within 21 days from the date of ET/bO'd “Sss2 @ quoud cS:8@ TO@2-6T-Ud 4/28/2801 18:44 305-634-2051 " NAVARRE pe PAGE 24 Jose F,. Navarro, President wo . Navarro Discount Pharmacies No 2, Inc. . . ; d/b/a Navarro Discount - Pharmacy $2 . . 2 Page 300°" ‘receipt of this letter, the right to such haaring if waived, and :repayment of the above-stipulated overpayme:3t will be. dv d ‘payable at the: end of that (21-day period. - ‘any ¢ questions that you may ‘have ‘regarding this. matter should be. directed to: Kelly D. Rubin, Senior Pharmacist, Agency for --.. ‘Health Care Administration, Medicaid Program Integrity, Office of the Inspector General, 2727 Mahan Drive, Mail Stop # 6,. .. ‘Tallahassee, Florida 32308- ~5403,_ Belephens.. umber, {839) 922: af 37.4 pre eccremnseeneengpenyrang ama ET eee Om Ne? ae aE REE ENE iy Sincerely, - D. Kenneth Yon Program Administrator. dels y Medicaid Program Integrity a ‘DEY/xdr S Attachment (s) ole] Medicaid Program Integrity Administrative Section Medicaid Accounts Receivable, Attn: Willie Bivens Heritage Information Systems, Incev;?"* Medicaid Program Development Area Medicaid Office ~ bovarros2uDRsstatiinvedeeRevi ewnAL.doc RECEIVED APR 50 2001 MEDICAID PROGRAM INTE, GRITY . . SEGA’ dear hes Me TaSSuD 3 qvoug ZS:FIA Taaz—eriwiu

Docket for Case No: 01-001971